Pyogenic Spinal Infections Pyogenic Spondylitis: Body involvement , starting in the endplates. Septic intervertebral discitis Spinal Epidural abscess

Presentation Acute Sub-acute - common. Chronic - common Average delay in diagnosis : 8 weeks to 3 months.

Presentation Usually have underlying infection source. C/o Back Pain - similar to mechanical LBP. Fever: Only 33% >100F( Garcia, JBJS 1960) Local tenderness may or may not be present. Muscle spasm +/- , Psoas Abscess Neurology in late cases. Symptoms much more than examination findings may suggest

Diagnosis Need a high index of suspicion. ESR/CRP - usually high - but non-specific. Bone scan - May be false negative( disc avascular). Or may show ‘degenerative change’ only. MRI - Best. High signal on T2 image . WBC count - unhelpful Blood cultures - during fever spike. +/-.

Diagnostic pitfalls No fever, no local tenderness. ESR high due to other causes. Bone scan negative. Referred pain - abdomen,’hip’, chest. May present with worsening of long standing mechanical low back pain. First pass investigations may be negative in early disease.

Predisposing factors Diabetes Rheumatoid Arthritis Other infections - urinary, chest, septicemia. I/V drug abuser Anti-cancer treatment Long term steroid use.

Mangement Confirm diagnosis WBC, ESR, Blood Culture. Percutaneous washout and biopsy in selected cases. Antibiotics for 3 months usually

Organisms Commonest is Staph. Aureus. Pseudomonas in immuno-compromised hosts. Could be Candida or TB.